Wednesday, July 01, 2009

Healthcare Unreality

In the health care debate we're about to get a heaping helping of socially constructed reality. The World Health Organization evaluated the health care systems around the world and the US is ranked 37th -- right below Costa Rica. The American medical system delivers less effective health care to fewer people at a higher cost. By any reasonable measure, that means we have something to learn from other systems.

Yet, we are incapable of admitting this. We will hear over and over again that we have the best health care system in the world when it is not true. Why are we incapable of admitting the truth?

My claim is that insecurity is the most important force in shaping American society. It manifests itself in two ways. In the middle class, it is class insecurity. There is the sense that our kids will not only fail to have more than we have, but that they may fall from being middle class. This is why schools are simultaneously turned into prisons providing environments that are not conducive to learning and overburdening our kids with too much homework. If they don't get into the right pre-school they won't get into the right college and then they might not end up with a good job. The kids are so risk averse that they refuse to think interesting thoughts. Just get the B, just don't screw up. It is there in the way we create gated communities both in terms of actual gates and in terms of infrastructure. We can't build public transportation because then the wrong kind would have easy access to our homes and our stuff. It's all fear of losing our stuff and our kids not being able to get it for themselves. Look at our drug laws, look at the way we pay for schools through property taxes, look at the discussions around affirmative action. The group of voters who went for Reagan and Clinton are governed by class insecurity and both of them knew it and played them like a fiddle.

The middle class doesn't want health care reform, not because they think ours is the best system in the world, but because it is good enough for them and they are afraid that helping someone else would be a zero sum game and thereby cost them. It works for me and mine so don't mess with it. Insecurity leads to malicious, selfish inaction.